Vitamin K Administration Prior to Geriatric Hip Surgery

Yechiel Gellman Raef Mahmoud Gurion Rivkin Amal Khoury Meir Liebergall
Orthopedic Department, Hadassah Medical Centers, Jerusalem, Israel

Background: Vitamin K antagonists (Warfarin) are a known cause for elevated INR, delaying hip fracture surgeries. Measures such as Vitamin K or Fresh Frozen Plasma administration are methods to counter their effect. Although this treatment is considered benign, we viewed many complications following this treatment. Therefore, we sought out to find whether our clinical results can be documented.

Patients and Methods: We conducted a retrospective computerized search amongst 755 geriatric patients which were operated for hip fractures between 2013 to 2015 in a level I trauma center. Of these, 70 patients received Warfarin prior to admission. These patients were divided in two groups: those which received vitamin K upon admission and those which did not. Demographic and surgical information was noted including vitamin K administration. Furthermore, complications during enoxaparin intake were noted and divided in cardiac, pulmonary, thrombotic and bleeding events.

Results: Seventy patients were found to have received Warfarin prior to original fall. Their average age was 81.4±7.2. Forty-one patients received vitamin K after being admitted to our orthopedic ward, while twenty-nine did not (seven of which were due to cardiologist instructions) . Patients receiving vitamin K were significantly older. No substantial difference was noted on anesthesia type (general vs. spinal), use of blood products including Packed Cells and Fresh Frozen Plasma. Platelets were only given in two cases. The average hospitalization days was not significantly different. As expected, time to surgery was significantly reduced by the vitamin-k receiving group (P<0.05). Complications rate did not differ between the two groups, including cardiac (arrhythmia and myocardial ischemia), pulmonary-related, thromboembolic and bleeding events.

Conclusions: Usage of vitamin K prior to hip fracture surgery has proven to be safe with a similar complication rate between patients receiving and non-receivers of vitamin K. the only most significant difference is in regard to early surgery which has been proven to decrease mortality in hip fracture. Vitamin K should therefore be given prior to surgery without hesitation.